Obamaâ€™s Health Care Speech

Thursday, September 10, 2009 at 06:17 PM EDT

Obama was careful to stress that there will be no health insurance for
illegal immigrants. Why does this matter? If a very sick illegal immigrant
shows up at a hospital, the hospital has to provide him with emergency care. If
a very sick and very old illegal immigrant shows up at a hospital, he will have
the same $250,000 death in the ICU as an American citizen. The current standard
of care does not consider costs and does not consider citizenship. Why would
people get excited over whether an illegal immigrant gets a free flu shot or
not? As far as the expensive stuff goes, weâ€™re already paying for it
(where â€œweâ€ includes the illegal immigrant, of course, since, as I
pointed out in my own health
care reform plan, illegal immigrants pay most of the taxes that citizens
pay).

Another point that struck me as bizarre is â€œmost of this
[multi-trillion dollar] plan can be paid for by finding savings within the
existing health care system, a system that is currently full of waste and
abuse. â€¦ The only thing this plan would eliminate is the hundreds of
billions of dollars in waste and fraud, as well as unwarranted subsidies in
Medicare that go to insurance companies â€¦ Reducing the waste and
inefficiency in Medicare and Medicaid will pay for most of this
planâ€.

The proposed changes to our health care system would start to be phased in
during the year 2013, according to H.R. 3200. If weâ€™re wasting hundreds
of billions of dollars a year right now in Medicare and Medicaid, why
arenâ€™t we taking immediate steps to stop the waste? Why would we wait
until 2013? Why would we say that weâ€™re only going to stop this waste if
we implement some unrelated changes to the U.S. health care system?

Speaking of immediate fixes, Obama says that the insurance market is not
very competitive: â€œUnfortunately, in 34 states, 75 percent of the
insurance market is controlled by five or fewer companies. In Alabama, almost
90 percent is controlled by just one company. And without competition, the
price of insurance goes up and quality goes down.â€ The federal government
pays for more than half the cost of health care in the U.S. The Feds regulate
all sorts of other things whose connection to â€œinterstate commerceâ€
is more tenuous. If the 50 state insurance commissions and licensing procedures
are reducing competition and raising pricings to consumers, why not get rid of
them tomorrow? Why wait until 2013 and predicate the efficiency improvement on
implementing unrelated new schemes?

The speech constantly equated health insurance with health care, as though
it were not possible to have health care without insurance companies, despite
the fact that a personâ€™s routine health care is predictable and
therefore
classically would not be considered something to be insured at all (except
against catastrophic accidents or rare disorders). Food is even more important
than health care. Without food, an American would be dead within just a few
months. Why donâ€™t we have food insurance if it is so much more important
than health care?

Nowhere did the speech mention the most obvious reason that our spending is
so high: Medicare, Medicaid, and private insurers pay providers more if they do
more and fancier procedures and tests. Nowhere did the speech mention any
proposed change to this practice, only that the government would spend more
money and hire more people to crack down on â€œfraudâ€ and
â€œabuseâ€ by providers. Given that medicine is not a science and
doctors often disagree on how to treat a patient, how is this ever going to
work? Someone at a desk in Washington didnâ€™t think the
doctor in Texas should have ordered an MRI, perhaps done at a MRI clinic
partially owned by that doctor? Did the desk jockey talk to the patient? Is the
desk jockey an MD? If not, how is he going to be able to say with authority
that the MRI wasnâ€™t necessary? Some of the words in the speech are fine,
but when one puts forward a specific example it is impossible to understand how
it could work in practice.

â€œFor some of Ted
Kennedyâ€™s critics, his brand of liberalism represented an affront to
American liberty.â€ Finally a part of the speech with which I can agree,
as there is no doubt that Ted Kennedyâ€™s brand of liberalism deprived Mary Jo Kopechne of
her liberty.